# Validation and factorial invariance of the breastfeeding self-efficacy scale-short form in Ecuadorian mothers

## TL;DR

This study validates a Spanish version of a breastfeeding self-efficacy scale for Ecuadorian mothers, showing it is reliable and useful for public health.

## Contribution

The study provides the first validation of the BSES-SF in Ecuador and confirms its factorial invariance across age groups.

## Key findings

- A second-order four-factor model of the BSES-SF showed the best fit and full factorial invariance across maternal age groups.
- The scale demonstrated excellent reliability and adequate convergent validity with psychological capital and positive mental health.
- One dimension of the scale had variance extracted values below the recommended threshold, indicating room for improvement.

## Abstract

Breastfeeding is one of the most cost-effective public health interventions to improve child survival and development. A key determinant of breastfeeding initiation and continuation is maternal self-efficacy, defined as a mother's confidence in her ability to breastfeed. The Breastfeeding Self-Efficacy Scale–Short Form (BSES-SF) is one of the most widely used instruments internationally to assess this construct. However, no validation studies have been conducted in Ecuador, and evidence from Latin America remains limited, particularly regarding advanced psychometric analyses.

To validate the Spanish version of the BSES-SF in Ecuadorian mothers with previous breastfeeding experience, examining its factorial structure, factorial invariance, reliability, and convergent validity.

An instrumental psychometric study was conducted with 325 mothers recruited from public and private health centers in Loja, Ecuador, who had breastfeeding experience during the child's first two years of life. Confirmatory factor analysis (CFA) was used to compare competing factorial models, and multi-group CFA tested factorial invariance across maternal age groups. Reliability was assessed using Cronbach's alpha and McDonald's omega. Convergent validity was examined through correlations with psychological capital (PCQ-12) and positive mental health (PMH-9).

A second-order four-factor model showed the best fit to the data (χ²/df = 1.39; CFI = 0.998; TLI = 0.997; SRMR = 0.043; RMSEA = 0.035) and demonstrated full factorial invariance across age groups. Convergent validity was generally adequate, although one dimension showed average variance extracted values below the recommended threshold. The scale showed excellent overall reliability (α = 0.915; ω = 0.929) and significant positive correlations with psychological capital and positive mental health.

The Spanish version of the BSES-SF is a valid and reliable instrument for assessing breastfeeding self-efficacy in Ecuadorian mothers. Clinically, it supports early identification of women at risk of low breastfeeding self-efficacy, facilitating timely and targeted breastfeeding support. From a public health and policy perspective, this psychometrically robust and culturally adapted instrument can inform breastfeeding promotion programs, equity-focused maternal health interventions, and monitoring of nutrition and health-related Sustainable Development Goals.